
27
Specialty Service Provider Relationships:
Advantages and Disadvantages of the Most Common Contracting Models
Originating site purchases
blocks of time from distant
site
: Guaranteed payment for time
Originating site pays per
patient seen
: No pressure to fill blocks of
: Possible excessive wait time
Distant Site: Difficult to forecast volume to plan
for coverage. AND
Assume risk for no
Originating site pays the
delta between distant site’s
cost and collections
: Only pays a portion of the
: Assumes the administrative cost
& burden of billing patient insurance & balance
billing originating site
Health Plan contracts
directly with specialty
service provider
Originating Site: Most sustainable model as the
originating site no longer has to pay for
specialty care
Distant Site:
Contracting with a health plan
allows the specialty group to expand access to
multiple sites, thereby increasing service
volume
Initial start-up delays in as health plans
are slow to contract with new providers.
Limited to those providers offered
through the health plan
Health plans will only pay by the
patient seen, which puts the Distant Site at
May pay for time that’s not
Guaranteed payment for time
: May provide more services than